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MassHealth has root issues when it comes to dental care

Sentinel & Enterprise

Updated:
03/13/2016 03:34:17 PM EDT

By BRAD AVERY

The MetroWest Daily News of Framingham

FRAMINGHAM, Mass. (AP) -- For Sharon Gagney, having MassHealth may have saved her life when it came to fighting breast cancer -- twice. But now, in dealing with the severe tooth decay that resulted from extensive chemotherapy, she says the Medicaid program has left her hanging.

Gagney, 57, of Framingham, is in need of five root canals. For anyone who has ever been on the receiving end of a root canal, the idea of needing five is downright grueling, but it has been a massive battle for Gagney to simply find a dentist who can do the procedure. MassHealth does not cover root canals, which has led Gagney on a years-long search to get her teeth repaired that has ended in her reluctantly making her way to Boston to get treated at a dental school.

"I've had breast cancer twice and I lost everything that I had," she said. "To get into Boston is a real hardship. I have to pay for tolls, for parking. I don't have an extra dollar to my name."

In addition to the financial burden, going to dental schools or clinics can involve long waiting periods, scheduling issues, and those who don't have access to a car may find themselves in need of transportation. Gagney has managed to have two of her root canals completed, but there are still more trips to Boston ahead plus visits to get crowns.

According to Dr. Edward Swiderski, president of the Massachusetts Dental Society in Southborough, the commonwealth cuts adult dental care from Medicaid programs during tough financial periods.

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In 2010, during the recession, MassHealth was slashed to eliminate nearly all dental coverage for adults who did not have developmental disabilities. Since 2011 the Legislature has been slowly rebuilding the adult dental plan, but getting treatment is still not a guarantee for some patients.

In 2013, coverage for fillings for front teeth returned. The next year, the state added $17.2 million to the budget to cover all adult cavity coverage, said state Sen. Karen Spilka, D-Ashland. In 2015, denture coverage was expanded and this year the state added another $16 million to the dental budget to continue to build the program. But there are still major gaps in coverage - principally root canals, but also gum and bone treatments such as scaling.

"It frustrates us," Swiderski said. "The patients can't come up with the money and unfortunately we can't do it for zero. ... When we deal with the Legislature they don't understand dental. They think they understand medical and try to apply the same models but we are very different."

According to Michelle Hillman, interim director of communications at MassHealth, there are 2,678 dentists in the state who accept MassHealth for general coverage. There also are 6,709 access points - meaning practices, community health centers and clinics - which take MassHealth. Of those, Hillman said 91 percent are accepting new patients. But, some offices may be limited in who they accept, taking children but not adults, for example.

The Massachusetts Dental Society represents more than 4,400 dentists in the state and of them about 40 percent accept MassHealth, Swiderski said. That number is up in recent years following the society's "Drive to 65" initiative which attempted to get 65 percent of its members to take accept MassHealth insurance. Unfortunately the campaign reached a plateau, but the Dental Society was able to change the law to better benefit dentists - most notably a case load capacity.

Prior to the capacity, dentists who accepted Medicaid - which includes the MassHealth program - were required to accept every patient who came to them. While it sounds good for patients on paper, the results for small town dentists could become overwhelming and most decided it was easier to just not take it.

Swiderski himself stopped accepting Medicaid at his Uxbridge practice in 1995 because of an extreme amount of patients coming in from Springfield and other far off urban regions. The capacity cap has allowed him to once again open his doors to those on state insurance programs, but he's still not able to take the entire rush of low-income patients who call his office.

"I still get calls from all over," he said. "Sadly somebody might have to call a bunch of names before they can find a dentist."

One solution currently working its way through the Legislature is a bill that would create avenues for dental hygiene practitioners to operate at clinics, schools and senior centers. According to state Rep. Kate Hogan, house chair of the Joint Committee on Public Health, other states such as Alaska and Minnesota have led the path for these types of practitioners who would be able to perform cleanings as well as more involved care such as diagnosing oral diseases, placing temporary crowns and perform non-surgical extractions.

"It's been done in other states and if we are supposed to be health care leaders we should have it as well," Hogan, D-Stow, said.

Swiderski said he would also like to see more preventative measures taken for patients. The Massachusetts Dental Society is endorsing legislation that would increase the number of communities fluoridating water systems.

But unfortunately for patients like Gagney, it remains uncertain when or if her root canal will be covered under MassHealth.

"As somebody who is a practitioner, we want to treat all people," Swiderski said. "And we would like to see the state help us out with coverage."

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